The invention relates to a surgical applicator tip for the setting of clips and clamps for connecting tissue during minimal invasive surgery.
Minimal invasive surgery equipment permits the performance minimal invasive surgery without the need for large cuts and without the formation of visible scars. Tissue parts are connected internally by clips or clamps using an applicator. Such equipment is used for example for surgery in case of fractures wherein stabilizing screens are connected to the tissue. Presently clips of titanium are used which cannot be decomposed biologically so that they remain in the body. Sometimes it is necessary to remove the titanium clips at a later date if they cause discomfort or pain. It is desirable to employ for the tissue connection clips of a material which provides for the necessary mechanical connection during the healing period of the wound but which, over an extended period, is fully disintegrated by the body by resorption.
Such clips are provided with claws which are closed like tongs by an application of a force and which then remain in the closed position. To handle and operate the clips, an applicator is needed by which the clips can be introduced into the body and set in a simple operating procedure.
It is therefore the object of the present invention to provide a surgical applicator with a tip for delivering and remotely setting clips or clamps in such a way that, on one hand, a sufficient number of clips or clamps can be stored in the applicator and, on the other hand, the clamps can be easily taken from the storage and brought into proper position for clamping.
In a surgical applicator tip for delivering clips used for connecting tissues, the applicator tip includes a magazine chamber, which receives a magazine with clips having tissue engagement claws and an operating mechanism by which the clips can be removed from the magazine and supplied to the front end of the applicator such that the claws project forwardly therefrom the applicator tip for piercing and engaging tissue parts. Each clip includes a shoulder with an elbow lever structure which, with the tissue pierced by the claws, is pushed against the shoulder whereby the claws are tilted toward each other for firmly holding the tissue parts in contact with each other.
Basically, the applicator comprises three main components: an operating handle, a connecting tube and an applicator tip. The operating handle serves to hold the applicator and includes means for controlling rotation and pivoting of the applicator tip as well as means for releasing and closing the clips. The connecting tube, which is extends between the operating handle and the applicator tip, includes actuating elements for operating the applicator tip which is disposed at the distal end of the connecting tube. The applicator tip includes a magazine for storing a number of clips, means for moving the clips and means for causing the clips to pierce the tissue and for closing the clips. The applicator is received for example in a trocar, which extends for example through a belly and seals the belly space, which is under pressure.
With the design of the applicator tip according to the invention, the clips are handled in a simple and efficient manner. The applicator tip accommodates the clips and the peripheral operating mechanism. The applicator tip is furthermore rotatably and pivotally supported. The clips have a particular shape: They are U-shaped with claw-like legs and are disposed on a storage bar supported by their shoulder portions. The shoulder portion are normally straight and are provided with elbow lever structures. The front clip is engaged by a stop provided at the free end of the storage bar. The subsequent clips are biased forwardly by a spring so that, upon removal of the front clips, the remaining clips move up. The storage or magazine bar is anchored at its rear end to a base plate by which a magazine lid is pivotally supported. The base plate is anchored in a recess upon insertion into the magazine cavity and is held in position by a spring force.
Below the stored clips, an axial movement mechanism is disposed comprising two plungers, that is, a transport and a closing plunger. Both are operated axially by an actuating wire extending through the applicator shaft to an operating mechanism in the operating handle. During forward movement, the closing plunger is first moved along with the transport plunger which engages the front clip of the clip magazine and carries it to the front end of the applicator tip, while, at the same time, pivoting it by 90xc2x0 to properly position it for installation at the applicator tips opening. There, the clip is held in position, while, at the same time, the closing plunger guided by way of a ramp abuts the elbow lever structure at its elbow joint.
In certain advantageous embodiments, the magazine lid may also cover the applicator tip. With a slight axial movement the lid is engaged in a locking recess in the wall of the applicator tip and is retained in this locked position by the force of a spring.
When the transport plunger is advanced below the clips suspended in the magazine it engages in the process with its two projecting prongs the front clip at cylindrical shoulder projections thereof.
The clip is moved through a guide groove in which the clip, when pivoted by 90xc2x0, is guided and which includes a spring structure, which prevents return movement of the clip.
When the clip has arrived at the end opening of the applicator tip, it is first retained in position by a retaining clamp until its claws are pressed into the tissue by the advancing closing plunger. When the claws are disposed within the tissue and the closing plunger is further advanced, the elbow lever structure is moved to a straight end position adjacent the shoulder of the clip, whereby the clip is closed.
The applicator tip includes a magazine chamber in which a sufficiently large number of clips are supported adjacent one another on the storage bar. The transport and closing mechanism is operated by a drive mechanism, which is simple in design and therefore reliable in operation. The shape of the interior of the applicator tip provides for proper guiding and final positioning of the clips for their accurate setting in the tissue parts to be joined.
The applicator tip and the clips will be described below as to their design and operation in greater detail on the basis of the accompanying drawings.